Medicare Claims Auditor: Precision, Compliance & Insights

LEON Health, Inc.; Miami (FL); On-site; USD 60,000 - 90,000; Full time

Job summary

LEON Health, Inc. in Miami seeks a detail-oriented Claims Auditor to ensure accurate and timely processing of healthcare claims.

You will perform pre-payment and post-payment validations, support reporting and testing, and manage data submissions while ensuring adherence to policies, guidelines, and provider rates. Minimum five years' claims processing experience; Medicaid/Medicare experience preferred; fluent in English and Spanish.

Qualifications

• Minimum of five years’ experience in healthcare claims processing.
• Medicaid and Medicare claim processing experience preferred.
• Bilingual English/Spanish language skills are a plus.

Responsibilities

• Apply Medicare Claim Payment rules and requirements to claims for payment.
• Enter claim data accurately and timely in line with production goals.
• Ensure claims payments are made within contractual time frames.
• Maintain a minimum 98% accuracy rate.
• Perform pre-payment and post-payment audits for proper coding and adjudication.
• Coordinate with Finance for payments, voids, and refunds; manage adjustments.

Skills

Medicare rules

LCDs & NCDs

CPT/HCPCS/ICD-10 coding

Pre/post-payment audits

Provider outreach

Billing requirements

Prior authorization

Education

High School diploma or GED

Tools

Medicare rules tooling

Job description

LEON Health, Inc. in Miami seeks a detail-oriented Claims Auditor to ensure accurate and timely processing of healthcare claims.

You will perform pre-payment and post-payment validations, support reporting and testing, and manage data submissions while ensuring adherence to policies, guidelines, and provider rates. Minimum five years' claims processing experience; Medicaid/Medicare experience preferred; fluent in English and Spanish.